Você está na página 1de 9



Build a More
Profitable Practice

Tackle Your Practices Fiscal Fitness.

Whats one of the best ways to increase your medical practices profitability? Is it through
greater efficiency in your office or better marketing? Consider these tactics to help improve
the financial health of your practice.
Most medical practitioners strive for a smoothly running practice, but benign neglect
toward its operation can lead to inefficiency. Given todays challenging world of health
care, its time to re-think even some of the simplest activities in your office.


Re-examining the fundamentals can show you how to improve the efficiency and
profitability of your practice. OPEN interviewed medical practitioners and consultants
about simple ideas to improve the way your office functions and metrics to help you
measure success. Just by taking a few incremental steps, you have the potential to grow
your practices revenues and improve your fiscal fitness.

PAGE 2 Tackle Your Practices Fiscal Fitness

Identify the Best Processes

PAGE 3 Five Surefire Ways to

Increase Referrals

This strategy concerns the workflow of administrative activities that you and your staff
do in both the front office and the back office. It also relates to the use of physical
space, from the reception desk to the exam room. Even a simple reconfiguration of
space can reduce the time employees spend passing files back and forth and make their
work easier and more productive. Especially if you have been in health care for awhile,
step back and take a fresh look at how your practice operates.

PAGE 8 Q&A: Establishing an Effective

Medical Partnership
PAGE 9 Four Strategies to Help Make
Medical Partnerships Thrive
PAGE 12 Engage in Low-Effort,
High-Impact Marketing
PAGE 13 How to Make the Web Work for You

Examine Your Scheduling Procedure. Some practitioners gain a sense of

comfort booking their schedules six weeks in advance, but that doesnt always work to
everyones advantage. Cindy Dunn, a senior consultant with the MGMA Health Care
Consulting Group, once analyzed the procedures of a large oncology group that had its
schedule filled that far out. But practitioners would tell their patients to come back in
three or four weeks. The receptionist had to take the request back to a nurse, who had
Article continued on page 5

Build a More Profitable Practice | 3



No matter how successful your health care practice is, you want to accommodate
new patients. Whether its to deal with the regular turnover of patients or to support
an expanding practice, its important to have new patients coming in the door,
especially if you are a specialist dealing with acute cases.
Improving the rate and quality of referrals doesnt have to consume much time.
Cindy Dunn, a senior consultant with the MGMA Health Care Consulting Group,
recommends five tactics:
KNOW YOUR REFERRERS. Keep a list of every practitioner who refers to you
as well as a list of practitioners you would like to have referring their patients
to you. Contact each one periodically to say hello and ask how you can make
the referral process easier.
ENSURE YOUR AVAILABILITY. Theres no use cultivating referring practitio-

ners if you have no appointments available when new patients call. Meet with
your staff to determine the best way to ensure that referrals are handled on a
timely basis.
MAKE IT EASY FOR THE PATIENT. Set up your Web site so referred patients

can find the information they need about your practice location, hours,
directions and any special instructions. Make printed copies available if referring
practitioners request them, too. Be sure the patients visit is a pleasant one,
because the first thing an unhappy patient will do after the appointment is
complain to the primary care practitioner. You may not hear about those
complaints, but youll eventually see the results when referrals diminish.
MAKE IT EASY FOR THE PRACTITIONER. Seeing a specialist is always daunting

for patients, so dont leave them or their primary care practitioner in suspense.
Set expectations on when you will have a consulting report back to them, and
fulfill that commitment. Also make sure primary care practitioners know their
patients are getting both appointments and results as quickly as possible.
SAY THANK YOU. In this fast-paced world, we often forget the small niceties. A
written thank-you note for a referral is highly memorable. It also doesnt hurt to
occasionally offer thanks in the form of a fruit basket or candy to the staff of a
primary care practitioner for their assistance in sending patients your way.

to find a space in the schedule and then ask the receptionist to call the patient back. It
was a waste of everyones time, but the problem didnt cost anything to fix. All they had
to do was change the process by leaving spaces open for returning patients, Dunn says.
Reduce Wait Time. An important metric to look at is wait time. Someone on your

staff can do this, or you may decide to hire an outside consultant to track this properly.
If you ask patients to come in 15 minutes before an appointment to complete forms,
but practitioners are left waiting because exam rooms arent available, the scheduling
process has a kink in it and its wasting everyones time. To avoid this, you can mail
or email forms ahead of time or have them available on your Web site for downloading. By adding proper security access features to your site, you could even allow
patients to enter this information online.

Conduct a Cost-Benefit Analysis. Some of the steps youre following to save

money may actually cost you money. Case in point: the staff at an orthopedic practice
shared a fax-copier machine near the receptionists desk. They did this to avoid having
two fax machines and telephone lines. However, when Dunn tallied the amount of
time back-office employees spent going to the front, either checking for an expected
fax or waiting for a fax to finish sending or receiving, the cost of wasted time alone
would have covered the expense of a second machine in just four weeks.

Improve Your Billing Practice

One of the best ways to help increase revenue is to ensure that you dont ignore income
sources already in place. The lifeblood of a practice is how it captures, obtains and
submits billing information, says Michael Lewis, director of healthcare consulting at
Cowan, Gunteski & Co., P.A. We see a lot of practices leave money on the table
because of incomplete billing practices.
Be Proactive About Billing. Mail explanations of benefits promptly. If you allow
them to sit for months before being billed, patients may call to complain about errors
that are too old to rectify accurately. Keep up with carriers fee schedules and match
your charges to the maximum allowable reimbursement. Be sure to verify insurance
coverage before the visit or ask for the co-payment right after the patient walks in the
door. You may find that a billing service that deals with the vagaries of insurance
carriers, even though it will retain a percentage of your billings, may be more costeffective than handling billing in-house.
Limit the Number of Carriers You Accept. Although your area may have only a
few insurance carriers especially if a large employer in the community uses a limited
number you can minimize the number of insurance plans that your practice accepts.
This allows your staff to focus on understanding those carriers procedures and develop
relationships with their counterparts at those companies. This can also help employees
deal with coding issues and other problems more quickly. Document best processes
and common errors to save employees time troubleshooting redundant problems in
the future.
Article continued on next page

4 | Build a More Profitable Practice

Build a More Profitable Practice | 5

Set Up a Web Site. Your Web site may very well be the first impression a prospective
patient gets of you and your practice. It reflects on you, so it should look professional.
As a general rule, your best bet is to hire an expert to design and host it instead of
trying to do it yourself or assigning the task to someone on your staff. This is not the
place for modesty; consider posting everything that will enhance your image or inform
patients or colleagues of your capabilities, including:

Your credentials
Your experience
Your location, hours and after-hours contact information
Text of or links to articles you have written
Appropriate volunteer efforts with which youre involved
Your blog if you write one
Inspect Your Financial Statements. Activities that make billing more efficient
mean that you and your staff can spend less time tracking down the money you are
owed. Apply the same oversight to the rest of your practice management. When a
cardiology group that grew accustomed to annual bonuses didnt receive any, its
members suspected the office manager of embezzling; she wasnt. But it turned out
that the members werent regularly inspecting their financial statements, when doing
so would have clearly shown that revenues were decreasing.

By gaining familiarity with your financial statements, you can determine areas where
you can trim expenses. Practitioners in well-run partnerships do this (see Q&A:
Establishing an Effective Medical Partnership on page 8), but those in solo practices
or who are simply sharing overhead with another doctor should do it as well. By
tracking patterns of spending and income, you can identify issues before they drain
your revenue.

Is Your Marketing Holistic?

Another tactic that can help increase revenues is to increase the number of patients
coming in by marketing your practice to the community. Successful marketing
requires a two-step process. You must first bring patients in and then ensure that
they are treated well so they come back. Here are a few tips.
Accommodate Your Specialists. If you are a specialist who relies on referrals

from primary care practitioners, you should establish an efficient process not only for
accommodating referred patients, but also for communicating test results and
diagnoses to the referring practitioners. This way, the referring practitioners will know
their patients have been taken care of and are more likely to refer to you again (see
Five Surefire Ways to Increase Referrals on Page 4).

6 | Build a More Profitable Practice

Updates and insights on news

(e.g., how to avoid heat prostration during a heat wave)
The secondary benefit of having complete information on your Web site is that it can
reduce calls to your office, which can help make your staff more efficient.
Ensure Your Employees Present a Positive Image. Marketing isnt just advertising;
its how your patients perceive the experience of visiting your practice (see Engage in Low
Effort, High-Impact Marketing on page 12). If your receptionist chews gum or discusses
personal issues with a co-worker while patients wait to check in, that unprofessional
behavior can affect patient satisfaction.
Offer Feedback Forms. One of the basic rules of marketing is that it is far cheaper
to retain a patient than it is to find a new one. Consider offering feedback forms
(anonymous or not) to patients so they can tell you what irks them rather than what
ails them. Set up a process to review the feedback and act on it.

In fact, most these methods of increasing practice revenues are intertwined. Efficient
administrative procedures beget efficient billing processes and, as noted, informative
marketing tools can increase staff productivity. You dont have to implement these
changes all at once, but you should remember that they relate to one another and that
progress in one area can also spur progress in another. Once you begin, the results
should clearly show up on your income statement. n

You dont have to implement these changes all at once, but

you should remember that they relate to one another and
that progress in one area will also spur progress in another.
Build a More Profitable Practice | 7


Building an effective medical partnership requires a simple prescription: you must
attend to its health and well being with the same care and concern that you devote to
the health and well being of your patients.
Kenneth Hertz, a member of the Medical Group Management Associations Health Care
Consulting Group with 30 years of consulting experience, recommends four tactics:

Q&A: Establishing an
Effective Medical Partnership.
Establishing a medical partnership has many financial benefits, but it requires substantial
planning and communication. Heres how to build a successful partnership.
Practice consultants frequently liken establishing a partnership to getting married. In fact,
sometimes the same questions come up. For example, you may think that asking Do you
want children? is only pertinent in a marital situation, but its also a question you should
answer when considering a medical partnership. Why? Because one partner going on
maternity or paternity leave will affect the schedule and the workload of the others.
Asking and answering difficult questions is part of establishing a successful partnership.
Success hinges on honest and forthright communication, both before you establish the
partnership and on an ongoing basis once it is under way.

REGULAR COMMUNICATION. Problems dont fester if they are brought into

the open soon enough. Set aside an hour a month for a practitioners meeting
to discuss day-to-day issues. For strategic issues, set aside a day for quarterly or
annual planning sessions. The staff should also have regular meetings to
discuss their issues, with practitioners attending on a periodic basis. Strive for
an environment in which colleagues can disagree and commit. In a successful
partnership, you can disagree but commit to move forward because you
respect each others opinions, Hertz says.
FINANCIAL OVERSIGHT. Maintaining financial oversight on a regular basis

doesnt mean becoming a CPA, but it does mean having outside professional
assistance or a practice administrator that will provide and explain the balance
sheet, accounts receivables and accounts payables, and your income statement.
This way, you can identify patterns and trends before they become problems.
TRAINING IN POLICIES AND PROCEDURES. A surefire way to create an

Marc Halley is co-author of The Medical Practice Start-Up Guide (Greenbranch Publishing,
2008) and CEO of Halley Consulting Group, a physician practice management and
consulting firm. As an expert who has put together practice groups and taken them
apart, Halley provides a cogent viewpoint on the characteristics that mark a successful
practice and an unsuccessful one.

ineffective practice is to shortchange your staff in training on either office

equipment or procedures. Make sure that when someone new comes on board
whether a practitioner or staff member they are trained properly and that
they have a clearly written set of procedures. Its also wise to ask employees to
review procedures on a periodic basis; they may have made improvements to
the process but didnt update the manual.


What should medical practitioners know about each other before forming
a partnership?

CELEBRATE YOUR SUCCESSES. Working in a practice can be hard for


They need to share a common vision regarding what the practice will look like initially
and what it will look like in the future. Certainly theyre all agreed that they will offer
clinical care, but what else? Look especially at practice growth. One practitioner might
Article continued on page 10

8 | Build a More Profitable Practice

practitioners and staff. Theyre invariably working with people who are in pain
and striving to help them get better. Because thats a good thing, its important
to set aside time to recognize and celebrate those victories. And dont limit it
to patient care: if someone figures out a way to save 20 percent on office
supplies, recognize that contribution as well.

Build a More Profitable Practice | 9

want to join a provider group with multiple locations and offer subspecialties. Another
might not want a group of larger than four, because she wants to know her partners
well and doesnt want to share calls for more than that many practitioners.


If they have agreed to grow the practice, they need to discuss methods of doing so. Do
they agree on ancillary services that the practice will offer? Some practitioners may not want
to attain even more certification, pay for new equipment or take on the legal liability for
offering such services. Who else are they going to hire to run the practice? Should you have
a practice administrator or just an office manager? If its a medical practice, will they use
physician assistants or nurse practitioners?


Sharing a common clinical approach is always good. One of the advantages of having
practitioners coming out of the same residency program is that they were trained similarly.
The practitioners on call are likely to manage patients consistently because they were trained
the same way.
Its also important to set up a structure for governance; that is, agreeing how you will
run the practice. This requires thinking about multiple contingencies what happens if
a practitioner or their spouse gets pregnant, what happens if one of the practitioners
becomes addicted to narcotics? Will you fire them or send them to rehab?
Finally, these days, its important to discuss technology. As practices increase their use of
electronic medical records or patient management systems, some practitioners who are
technogeeks love it and others are petrified of it.


You mentioned the idea of destructiveness and that you have had to
dismantle practices. What are the major reasons practices fail besides lacking
a common vision?
Partnerships can fail because of a lack of dialogue. Either no ones talking, or one
practitioner is dominant and doesnt let others speak. In that case, conversations are
frequently held behind closed doors. Meanwhile, the staff isnt getting direction, and
the confusion begins to affect the practice. In that case, you may have five practitioners
who are each in solo practice, but they just dont realize it yet.
Practitioners have to tackle difficult conversations. Even if they bring different points
of view and agendas to the conversation, they still have to make the best decision
for the practice and come away as friends. This is difficult in any organization, and
especially with medical practitioners. Its hard to criticize or discipline a peer because
you are dependent on them for revenue and call coverage. But you have to be able to
have that depth of conversation and to be grateful that the subject was broached.

10 | Build a More Profitable Practice

You have to build a culture of accountability. I recently co-authored an article

highlighting the difference between high-performance practices and those that
didnt perform well. In the former, everyone practitioners, staff, administrators
is expected to perform well.
In order to hold people accountable, you have to have a dialogue with them to regularly
emphasize expectations and policies. Then you have to stick to them. Ive seen situations
where the group decides on a policy, but then one of the practitioners tells a nurse or a
technician in private that they can ignore it. That only causes problems.

What kind of cultural issues should practitioners consider?

Its important to discuss work ethic, especially if an older practitioner is bringing in
a younger one, say, to eventually take over the practice. Practitioners in their 50s
and those in their 20s have a vastly different work ethic. It can be very destructive if
colleagues dont share that work ethic. Nothing will cause a partnership to come apart
faster than people who arent generating revenue. In any group, as the supply of food
gets smaller, the table manners change.

What do you recommend for building this kind of practice?

If communication breaks down, bring in an outside facilitator to establish or re-establish

basic dialogue skills. You have to make it safe to express opinions. Unless everyone can get
past being mad at each other, nothing will work toward fixing the problem. It may take the
involvement of an outside facilitator whose ox hasnt been gored to get the dialogue going
again. This is especially important in a smaller practice thats less likely to have professional
management, where the practitioners are the managers as well.


It sounds like its easy to recognize a dysfunctional partnership. You mentioned

a culture of accountability, but what are some other signs of a highly effective
medical partnership?
Its one thats growing and showing an innovative spirit. In a healthy partnership, the pie
is growing so fast no one has any time to complain. When one team member falls behind,
another one jumps in to help. Everyone makes the effort to improve performance and
customer service. People are willing to take risks because they dont get blamed if they try
something new and it doesnt work. An easy way to track this is by looking at your
turnover. If your people have been around for a while, it means theyre probably happy.
An effective medical partnership also depends on its governance structure. Look at
the Mayo Clinic or the physician-owned Cleveland Clinic. They didnt get that big
without effective governance, without a clear structure for how work is done and even
how changes are implemented. But that goes back to your vision for your practice. If
colleagues establish constructive dialogues at the beginning, and that dialogue
continues, with everyone being held accountable for the tasks theyve agreed to
perform, then youre on your way to a highly effective partnership. n

Practitioners have to tackle difficult conversations. Even if they

bring different points of view and agendas to the conversation,
they still have to make the best decision for the practice.

Build a More Profitable Practice | 11



Keeping up with the many options for marketing your practice on the Web is daunting.
But you dont have to tackle them all at once. By picking one or two key methods of
electronic communication, you can easily and efficiently establish or maintain communication with your patients and colleagues. Try these four tactics to get started.
MAKE YOUR WEB SITE MORE INTERACTIVE. Consider using your Web site as
a way to make patients lives simpler by allowing them to input their information onto forms before going to your office. While this may require hiring an
outside Web expert to add secure, protected access to your site, the convenience
it provides may be worth it. You may also decide to allow current patients to
access test results online (you can do the same for referring practitioners, too).
Normal results might not even require a follow-up call, just an e-mail message
with a link to the results. You save your time and your patients time, something
they may remember when they are asked to recommend a practitioner.

Engage in Low-Effort,
High-Impact Marketing.
Marketing doesnt have to be expensive or time-consuming. You can employ simple methods
that can benefit your practice and enhance your image.
There are almost as many methods to engage in marketing as there are medical specialties.
As a result, medical practitioners have come to little consensus about the best methods
for marketing.
Finding and addressing your target audience efficiently can be daunting. You can do this
with an existing patient list, or, if youre a specialist, by compiling a list of primary care
practitioners in your area. Other factors include the methods of communication you
choose (whether old media or new), and your comfort using the latest electronic tools.
The key is to do it on an ongoing basis.
Dr. Lynn McMahan, an ophthalmologist at Southern Eye Center in Hattiesburg, Miss.,
and American Express OPEN Business Cardmember, markets his practice extensively
through television, newspapers and community involvement. Although his practice is
considering some social networking options, hes more traditional in his outlook.
On the other hand, Dr. David Wong, a periodontist in Tulsa, Okla., advises using a
wider set of tools, including online marketing (for tactics on using online marketing
tools, see the sidebar How to Make the Web Work for You on page 13). Dr. Wong, who
consults with dentists on their own marketing strategies, has simple advice on marketing:
You have to hit them from all angles.
Whether you decide to follow a traditional or online route, or a combination of the two,
heres a roadmap to help you get started.
Article continued on page 14

12 | Build a More Profitable Practice

EXPAND YOUR VISIBILITY WITH A BLOG. Blog topics are endless recurring
symptoms youre seeing with your patients, national health news as it pertains
to your patients, diet tips or an excerpt from a news article that you found
interesting. But a blog can be more than a forum for talking about medical
developments and journal articles. Search engines look for Web content thats
not only pertinent but timely. If you blog frequently, your blog can or may
show up higher in search engine results requested by prospective patients or
people looking for experts, such as conference organizers looking for speakers.
Yellow Pages for a health care professional, people are more likely to go to social
networking sites such as LinkedIn or Facebook to find out about a practitioner.
These sites also allow you to let established patients post recommendations for
your services. By setting up groups for patients or colleagues, you can communicate
with them privately about new services or appointment reminders.
CHECK OUT TWITTER. Twitter is another social network thats booming. This
site lets you broadcast messages of up to 140 characters (known as tweets) to a
group of people, your followers. While you might first think of Twitter as a
way for teenagers to notify each other of their whereabouts at the mall, consider
the value of a specialist attending a conference and sending updates of interesting
findings to colleagues or primary care practitioners who refer to you. Its a way to
share valuable and timely professional information and establish your position as
a knowledgeable source.

Build a More Profitable Practice | 13

Make Sure You Are Ready for New Business

Prior to embarking on a marketing program, make sure your practice is ready to
accommodate the new business. Before you start marketing, you have to make sure you
have a good product, says Dr. McMahan. If you open a restaurant, you have to make
sure the food tastes good. If you want more people in your practice, you have to make
sure your office is running smoothly.
Questions to ask yourself and your staff:

Are enough appointment times available in the schedule?

Are you properly staffed to accommodate an influx of new patients?
Do you have sufficient office space to handle more patients?
If you answered no to any of those questions, you take the chance of enticing new
patients to come through your door and then delivering a poor experience. Then youve
only wasted your marketing dollars and made it harder for your practice to grow.
The best advertising can be word of mouth, Dr. McMahan says. To do this, you have
to make sure that your system delivers optimal experiences that will make people want
to come back and recommend you to others. We want our patients to be more than
satisfied, we want them ecstatic. People are frequently scared of eye surgery, so we work
to make it a positive experience. This includes singing Amazing Grace (I once was
blind but now I see) and handing out lollipops.

Use Newsletters to Promote Your Practice

A newsletter can help you stay in touch with your patients or referring practitioners. If you
communicate with other professionals, it helps establish you as an expert who is up-to-date
on the least issues. For patients, it reflects your interest in maintaining their health on an
ongoing basis, not just at checkup time. It can also be a marketing tool. When patients
receive a newsletter from you, Dr. McMahan says, theyll take it to their neighbor and
say, Heres someone who can help you. Your patients become your ambassadors.
Another advantage: if you proactively send a newsletter alerting patients to the
symptoms of whatever malady is in the news that week or month, you can help stop
time-consuming calls to your staff.
Share Your Knowledge. What should be included in your newsletter? Offer tips
relevant to your practice, such as getting children to floss or following a proper weightloss program. You can also offer timely advice based on seasonal issues, such as how
patients can decrease their chances of getting the flu. Save space for advice thats good
anytime, such as how to locate a health care professional when traveling. The same
concept works when e-mailing referring practitioners. Either way, it establishes you as an
expert who understands the needs of your patients and colleagues.
Track Your Results. Practitioners disagree on whether paper newsletters or e-mail

newsletters work better. Both are easy to hand off to friends, either physically or
electronically. A key benefit of e-mail newsletters is that the results are easy to track.
Using an e-mail newsletter service such as Constant Contact, an American Express
OPEN partner, you can see who received the newsletter, who opened it and what links

14 | Build a More Profitable Practice

they clicked on. This can help you determine which topics interest your patients most.
You can also use Constant Contact to survey patients and compile information about
other services they might want to see.
Dr. Wong uses an outside service to design and distribute the newsletters to his
mailing list at a rate of $1,000 for 400 newsletters (40 cents apiece). You may get a
response rate of only 2 percent or 3 percent, but if you mail 2,500 newsletters and
25 prospects respond, thats a viable result.
Consider Integrated Marketing. Many practices can benefit from marketing

programs that encompass traditional advertising, Web sites and e-mail. If your services
are generally elective, you can periodically use a print advertisement in local newspapers
with special coupon offers available through a specific Web site address. This allows you
to track how many people respond to each particular offer (letting you test whether
high-value or short-expiration coupons work better, for instance), as well as allowing
you to capture e-mail addresses in exchange for coupons or other information. You can
then use these e-mail addresses for other follow-up communications.

Personal Interaction Still Works

Many patients and referring practitioners prefer more personal interaction. You can
generate considerable impact by simply going out and talking to people. For something
as important and personal as health care, prospective patients find reassurance when
meeting a practitioner face to face before they commit to an appointment.
Get Involved in Your Community. For all practitioners, especially those who are

just starting out, its especially important to be seen in the community, insists Dr.
McMahan. He recommends joining the local Chamber of Commerce, the PTA or a
service club. When I go to a Lions Club meeting, more than half of the people there
are my patients.

While some practitioners may prefer one-on-one interaction to standing in front of a

group, you can derive an enormous payoff from these activities. Sponsoring charities
and events can also raise your profile in the community. For instance, an orthodontist
or dermatologist whose clientele are weighted toward adolescents should work with
youth-oriented charities.
Network with Potential Partners. If you are a specialist who relies on referrals,
you need to network so those primary care practitioners get to know you. Consider
inviting potential references for a game of golf or dinner; these can not only be fun and
relaxing for you and the other practitioner, but the expenses are tax deductible as well.

Once these practitioners become part of your support system, dont drop them from your
social calendar. Engaging current referring practitioners allows you to receive feedback
about how patients were treated, how to improve the communication of lab results and
other insights into the process. (For more tactics to increase referrals, see Five Surefire
Ways to Increase Referrals on page 4.)
Marketing isnt something you do once and then forget about. For best results, build
your marketing work into your schedule, even if its only an hour a week so it becomes
part of your routine. n
Build a More Profitable Practice | 15

To learn more about our products and services,

call 1-800-NOW-OPEN or visit us at www.open.com
For more OPEN Book Insights, and other resources to help you
grow your practice, visit www.openforum.com
Copyright 2005-2009 American Express Company. All Rights Reserved. The information contained in this document is meant for advisory
purposes only. American Express accepts no liability for any outcome of its use.